NPI | 1003566589 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 6274) |
Enumeration Date | 2022-03-27 |
Last Update Date | 2025-06-10 |